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  Citation statistics : Table of Contents
   2014| July-September  | Volume 20 | Issue 3  
    Online since July 16, 2014

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Prevalence of occupational noise induced hearing loss in industrial workers
Rupender K Ranga, SPS Yadav, Ankush Yadav, Neha Yadav, Saroj Bala Ranga
July-September 2014, 20(3):115-118
Introduction: Occupational noise induced hearing loss causes sensorineural hearing loss (SNHL) in industrial workers who are continuously exposed to high frequency noise due to degeneration in hair cells and associated nerve fibers. Materials and Methods: This study was conducted in 100 industrial male workers, including officials, machinery operators, and helpers. ENT and audiometry examination were done and noise level was measured. The age, noise level, duration of exposure, type of activity, and measurement of hearing loss were co-related. Results: The workers who worked in machinery area were affected more when compared to official and helpers. The age group 36-40 was affected more when compared to other age groups. Conclusions: Chronic exposure to noise is common hazard in industrial workers that affect bilateral cochlea and causes high frequency SNHL with 4 kHz notch. We observed 39% industrial workers who were exposed to noise level >87.3 dBA, for 8-12 h/day in textile and hard strip rolling mills in spite of noise free machine are recommended suffered from SNHL.
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High-riding jugular bulb: A rare entity
Vivek Sasindran, Antony Joseph, Shobin S Abraham, Shivaprakash B Hiremath
July-September 2014, 20(3):129-131
We present a case of high-riding jugular bulb that obscured the round window niche causing gradual hearing loss. Encounters with the jugular bulb in ear surgery are uncommon.
  3 15,021 623
Mastoid osteoma
Umesh Chandra Parashari, Sachin Khanduri, Nidhi Singh, Samarjit Bhadury
July-September 2014, 20(3):132-133
Osteomas are benign tumors of mesenchymal origin. Osteomas of head and neck origin have been described, but mastoid osteoma form a rare entity with only 150 cases being reported in the literature. Osteomas of the mastoid bone are usually asymptomatic but may cause cosmetic deformity. We reported a rare case of mastoid osteoma in a young female with a hard swelling in the postauricular region, which was clinically asymptomatic, but causing cosmetic deformity and gave unseemly appearance. On imaging studies, radiographs of skull showed a dense radiopacity in the mastoid region and noncontrast computed tomography of the temporal bone showed a densely calcified lesion of bone attenuation in left mastoid.
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Our experience with cochlear implant surgery on Nigerians
Samuel Agida Adoga, Ogbonna George Benjamin Nwaorgu, Joel Anthis, James Douglas Green
July-September 2014, 20(3):134-139
Over 250 million people suffer various degrees of hearing loss globally with 75.0% living in sub-Saharan Africa out of which about 2.8% resides in Nigeria. The degrees of hearing loss vary from mild to profound. Cochlear implant is the preferred treatment for profound hearing loss. However, the treatment for severe to profound hearing loss is very challenging in our environment. It is thus the aim of this communication to highlight our experience in the management of the profoundly deaf over an 8-year period. Six patients had cochlear implantation (CI) for profound hearing loss made up of four postlingual and two prelingual hearing loss implanted 17.5 and 1.8 years, respectively after onset of hearing loss. The first two were done as inpatients in Nigeria (2005); whereas, the rest were as day cases in USA (2012). Their ages ranged from 3 to 50 years with an average age of 29.8 years. Prophylactic antibiotic were administered to the Nigerian group, while the USA group had full 10 days antibiotic course. The Nigerian group had explantation, but one patient out of the Nigerian group later had successful implantation on the opposite ear in USA. The implantation in the United States group was uneventful. The prelingual deaf are still undergoing rehabilitation; whereas, all the previous postlingual deaf patients have resumed work. CI for the profoundly deaf is feasible in Nigeria with proper planning, collaboration between local and international teams. However, there is the need to ensure an optimal environment and personnel training for a highly successful cochlear implant program in Nigeria.
  2 3,472 252
Evaluation of different graft material in type 1 tympanoplasty
Kshitij Patil, Nitish Baisakhiya, PT Deshmukh
July-September 2014, 20(3):106-114
Aims and Objective: The present study was undertaken to compare the results of various autogeneous tissues temporalis fascia, tragal perichondrium, and fascia lata as graft materials for the type 1 tympanoplasty. Materials and Methods: A total of 120 cases with large, subtotal and total perforation were considered in the study. Of the 120 cases, temporalis fascia graft was used in 60 cases (Group-I), tragal perichondrium graft in 40 cases (Group-II), and fascia lata graft in 20 cases (Group-III). The results were evaluated in the form of rate of graft success, hearing gain, and mean residual air-bone gap with respect to the graft materials. Results and Observation: A nonsignificant association was observed between the groups, that is, temporalis fascia (Group-I), tragal perichondrium (Group-II), and fascia lata (Group-III) and the graft uptake. (P = 0.96 > 0.05) and air bone closure (χ2 = 2.908, P = 0.059 > 0.05). Conclusion: The graft take-up rate and Hearing improvement are similar for the different graft materials used. Size of the perforation doesn't significantly influence the success rate of tympanoplasty as per our study. Normal translucent appearance of neotympanum in the postoperative period was seen only with temporalis fascia, while in tragal perichondrial and fascia lata grafts the neotympanum was whitish, thicker, and translucent to opaque.
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Avulsion of malleoincudal complex with dislocation: A rare ossicular chain injury by using an indigenous claw-like ear hook with review of literature
Produl Hazarika, Seema Elina Punnoose, John Victor, Rajeev Chaturvedi
July-September 2014, 20(3):146-149
Direct ear trauma through external auditory canal causing an avulsion injury of malleoincudal complex is a grievous injury that can happen during ear cleaning with indigenous ear hook. One such case of avulsion injury is presented here with its symptomatology, investigation, and management with the review of available literature because of its rarity. Various locally designed indigenous ear hooks are available in street side markets and even online for purchase and used by many without knowing its ill effects on health. Injury caused by these types of hooks may lead to a severe hearing disability, if not properly treated. This presentation is to highlight the fact that indigenous ear hooks; rampantly available online for purchase can cause a potentially major injury leading to hearing disability and thereafter poor quality of life. Reporting and highlighting of such incidents among the ENT community can help increase the public awareness; thereby, eliminating such disastrous consequences. Wikipedia, PubMed, and Google search engine has been used for our data collection and analysis.
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Ossicular chain defects in safe type of chronic suppurative otitis media
Manas Ranjan Rout, Pakeer Das, Deeganta Mohanty, Venkateswar Rao, Karri Susritha, Bolla Eswari Siva Jyothi
July-September 2014, 20(3):102-105
Introduction: Chronic suppurative otitis media (CSOM) is a long standing infection of middle ear cleft having a permanent perforation in the tympanic membrane with or without discharge. This is of two types; tubotympanic and atticoantral disease. Tubotympanic type of CSOM is called safe type, because the rate of complication is very low and usually not associated with cholesteatoma. Ossicular chain involvement is found in both safe and unsafe type of disease. In safe type though the involvement of ossicular chain is less common, still significant numbers of patients are having hearing deterioration due to it. Materials and Methods: Present study has been conducted in the Department of Ear, Nose, and Throat (ENT), Alluri Sitarama Raju Academy of Medical Science, Eluru, AP (India). Study group includes 200 patients having safe type of CSOM selected from ENT outpatient department (OPD). Preoperatively, all patients were evaluated to identify ossicular involvement. Then they were evaluated per operatively for confirmation of preoperative findings under microscope. Results: It was found that 74 patients out of 200 are having some amount of ossicular involvement in the form of ossicular necrosis, ossicular tympanosclerosis, or ossicular fibrosis, that is, 37% cases. Thirty-eight patients are having ossicular necrosis, that is, 19% cases. Conclusion: So our study shows that in safe type of CSOM, approximately one-third patients are having some amount of ossicular involvement and one-fifth patients are having ossicular necrosis. So as an ENT surgeon, we should be competent enough to do the ossicular chain reconstruction during surgery to give the best hearing results to our patients.
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Transtympanic dexamethasone - sudden sensorineural hearing loss
K.V.S Kumar Chowdary
July-September 2014, 20(3):140-142
Transtympanic (medical) therapy is an attractive and convenient technique gaining acceptance all over the world, where the drug is placed in the middle ear with the intention of treating inner ear diseases like hearing loss, vertigo, and tinnitus. We report a case of sudden hearing loss managed with transtympanic injection of dexamethasone improving the hearing loss and tinnitus almost completely.
  - 2,923 224
Neurobehcet syndrome: Ear canal ulcer with ipsilateral facial nerve palsy: A rare presentation
Jaskaran Singh Gill, Bhanu Bhardwaj
July-September 2014, 20(3):143-145
Neurobehcet syndrome is the disease with multisystem involvement. It has known otological manifestations which mainly include hearing loss due the involvement of the labyrinth. Though literature reports some cases of Neurobehcet disease with facial nerve palsy, it is one of the rarest presentations. The diagnosis of neurobehcets is mainly based on the symptomatology as no definitive pathological tests are available. As an otologist is one of the first clinicians to come across a patient with facial nerve palsy, we report this case of neurobehcets disease presenting to us with an ear ulcer and ipsilateral facial nerve palsy.
  - 2,924 232
Scleroderma and sudden sensorineural hearing loss
Ravinder Verma, Ravneet Ravinder Verma, Rohan Ravinder Verma
July-September 2014, 20(3):123-125
Sudden sensorineural hearing loss (SNHL) is an emergency in otolaryngological practice. The exact cause, in most of the cases cannot be found. A triad of vascular, viral, and membrane rupture are the known theories for the causation of sudden SNHL. Now various autoimmune disorders have also been suggested to play a role in the pathogenesis. Autoimmune inner ear disease in human being is an uncommon, but a distinct clinical entity. The diagnosis of the inner ear autoimmune disorder depends mainly on relatively distinct clinical course, immune laboratory tests and treatment response. The clinical picture usually consists of bilateral SNHL, bilateral reduced vestibular loss and symptoms of pressure with tinnitus and rarely tissue destruction of middle and external ear. Systemic scleroderma is an aggressive multi-system and multistage connective tissue disorder with high mortality. It is characterized by proliferative vascular lesion and marked deposition of collagen in various tissues and organs. Responses to immunosuppressive drugs are cited as evidence of an autoimmune process.
  - 8,703 244
Persistent bilateral function after unilateral facial nerve transection
A Sehgal, R Lichtenbaum, MI Redleaf
July-September 2014, 20(3):126-128
To indicate that occasionally the contralateral facial nerve provides redundant innervation to the hemi-face. Single case report. We report the case of a patient whose facial nerve was transected during removal of a 3 cm vestibular schwannoma. Postoperatively, this patient still demonstrated spontaneous mimetic motion on the side of the face ipsilateral to the transsection. Review of the literature finds rare instances of preserved function after nerve transection in the removal of large parotid masses. We speculate that the slow loss of ipsilateral function can at times contribute to innervation from the contralateral facial nerve.
  - 1,677 186
Post-traumatic vertigo
MK Taneja, Vivek Taneja, Himanshu Varshney
July-September 2014, 20(3):95-98
  - 4,222 642
Is Keratosis obturans a predisposing factor for external auditory canal cholesteatoma: Some interesting cases
Rajnish Chander Sharma
July-September 2014, 20(3):99-101
Aim: To define that Keratosis Obturans is one of the predisposing factor for External Auditory Canal Cholestetoma. Materials and Methods: 920 patients were analysed retrospectively between July2012- March 2013 with history of dull earache, fullness and cerumen in External Auditory Canal. The External Auditory Canal examination was done only after removal of Cerumen. Result: Total 920 patients were examined and wax was removed sucssfully except in three patients where it was removed manually under cover of analgesic and antibiotic. After this examination of External Auditory Canal, tympanic membrane, middle ear, ossicles was done clinically. In case -1,only inflammation was present. In case -2,both inflammation as well as widening of bony part of EAC was present along with perforation of TM left side. In case-3, erosion in the bony part of EAC with cholesteatoma sac. On CT scan ,there was no extention of the disease process. Conclusion: KO is uncommon and occurs mainly as desquamative process of ear canal. Both KO and EACC has overlapping of sign and symptoms to some extent.KO is common in comparison to EACC and later usually occur in long standing or in neglecting cases of KO.
  - 4,778 506
Clinical presentation and audiologic findings in pediatric auditory neuropathy
Navneet Gupta, Deepanshu Gurnani, Vikas Sinha, Pawan Sharma, Sachin Jindal, Ambuj Pandey
July-September 2014, 20(3):119-122
Aim: of the study was to rule out audiologic findings, related etiologies and its effect in pediatric patients having hearing deficits that are most likely due to a neuropathy of the eighth nerve. Study Design: Retrospective neo-natal hearing screening programme based. Subject and Methods: Subjects include 30 children aged from 0 yrs to 12 yrs, were tested with pure tone audiometry, behavioral observation audiometry, free-filed audiometry, speech audiometry, auditory brainstem response, and click evoked otoacoustic emissions. Results: Pure tone and free-field testing revealed 40 ears (66.67%, n = 60) with sloping type, sensorineural hearing loss, 20 ears (33.3%, n = 60) had flat configuration. Out of this 18 (6%, n = 30) subject showed bilateral similar configuration (either bilateral sloping type/ flat type of audiogram). Rest 12 (40%, n = 30) subject showed bilateral different pattern. 10 (33.3%, n = 30 children demonstrated fair to poor word discrimination scores and the other 2 (6.67%, n = 30) had fair to good word discrimination. For other rest of 18 (60%, n = 30) children speech test couldn't be performed because of age limit and poor speech and language development. Out of 30 subjects 28 (93.3%, n = 30) showed normal distortion product Otoacoustic emissions and 2(6.67%, n = 30) subjects showed absent emissions. Conclusions: All thirty children demonstrated absent or marked abnormalities of brainstem auditory evoked potentials which suggest cochlear outer hair cell function is normal; mostly lesion is located at the eighth nerve or beyond. Generally auditory neuropathy is associated with different etiologies and it is difficult to diagnose auditory neuropathy with single audiological test; sufficient test of battery is required for complete assessment and diagnosis of auditory neuropathy
  - 2,253 260